A 66-year-old man presented with dysphagia and weight loss of more
than 20 % in a 3-month period. His past medical history included
total laryngectomy and left radical neck dissection for laryngeal cancer in
1999. Later he underwent right radical neck dissection and insertion of an
esophageal Blom–Singer voice prosthesis in 2000. The patient had adjuvant
chemoradiotherapy. He had lost 11 kg within the last 3-month period.
Upper gastrointestinal endoscopy revealed a tumoral mass obstructing the
esophageal lumen at 28 cm distal to the incisors. Meanwhile, the
endoscopist also noticed a foreign-body-like object 14 cm from the
incisors ([Fig. 1]) and nearby a small
papillomatous lesion. The material of the object was completely unknown to us
and a brief consultation with a laryngologist prevented us from taking it out
with a snare. The object was a voice prosthesis.
Fig. 1 Foreign-body-like
appearance of the voice prosthesis during endoscopy.
There has been an increasing tendency for voice rehabilitation after
total laryngectomy. Techniques used are the esophageal voice, electronic
devices, and the voice prosthesis. In the last, the voice prosthesis, acting as
a one-way valve, enables pulmonary airflow from the trachea to enter the
esophagus, while preventing backflow of esophageal contents into the trachea
[1]. Provox is one such prosthesis and is made of
silicone. This prosthesis has been in use since the 1980s. Tracheoesophageal
prosthetic voice replacement has become widely accepted internationally
[2].
It is essential for endoscopists to be familiar with this prosthetic
device so that they do not remove it by mistake. Consultation with a
laryngologist should be helpful in the appraisal of any material in an image
encountered during endoscopic evaluation of laryngectomized patients.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH
